Using chlamydia positivity to estimate prevalence: evidence from the Chlamydia Screening Pilot in England

Studies have suggested that positivity can be used to estimate the prevalence of Chlamydia trachomatis in large-scale chlamydia screening programmes. A recent pilot of opportunistic screening in England estimated that the prevalence among 16–24-year-old women in Portsmouth and Wirral was 9.8% and 11.2%, respectively. This study assessed the continued validity of positivity as an approximate for prevalence. We re-analysed data from the Chlamydia Screening Pilot to estimate positivity, calculated as total positive tests divided by total tests, and compared these estimates with the previously reported prevalence, measured as the number of women testing positive divided by the total number of women screened. Overall positivity was 9.4% in Portsmouth and 11.0% in the Wirral; these estimates were not statistically different from prevalence, regardless of health-care setting, age group or symptoms. We conclude that positivity can be used as a proxy for prevalence.

Failed postnatal immunoprophylaxis for hepatitis B: characteristics of maternal hepatitis B virus as risk factors

A retrospective case-control study was conducted to determine why some infants born full-term without obstetric intervention to hepatitis B e antigen (HBeAg)-seropositive mothers become infected by hepatitis B virus (HBV) despite having received passive-active immunoprophylaxis. Cases and controls comprised 12 hepatitis B surface antigen (HBsAg)-seropositive infants and 22 HBsAg-seronegative infants, respectively. Infants infected by putative vaccine-escape mutants were excluded. Risk factors, after adjustment for the level of maternal viremia, were the following allelic base changes in maternal HBV:C158, A328, G365, and A479 (P = .017, .005, .003, and .005, respectively). High-level maternal viremia (i.e., > or = 10(8) genome equivalents/mL) was a significant factor only after adjustment for G365 (P = .027). HBV DNA sequences recovered from one of the cases, the case's mother, and three infected contacts all had the high-risk mutations. Specific allelic mutations in maternal HBV and level of maternal viremia are potential predictors of vertical breakthrough infection.

An update on HIV-testing at a London sexually transmitted diseases clinic: long-term impact of the AIDS media campaigns

Trends in the number of tests for HIV-1 antibody at a London sexually transmitted diseases clinic showed substantial changes between September 1985 and June 1988. From an average of 100 tests per month between September 1985 and August 1986, the average increased to 365 tests per month for September 1986 to August 1987. This levelled off at 243 tests per month between September 1987 and June 1988. The average number of positive tests per month between September 1985 and June 1988 remained constant, though the number of seropositive tests in females increased. Male and female populations displayed similar temporal patterns. The greatest increase was seen in the tests generated by heterosexual males and females with no other risk factors. This group generated 42% of the 8012 tests performed during the study period. The Clinic's catchment area predominantly included London and surrounding areas and temporal patterns were similar for residents from each of the Thames Regions. The temporal patterns observed coincided with periods of increased media attention on HIV infection/AIDS and involved campaigns by the popular press, television, Department of Health Education Authority. The increase in tests during the time of maximum media exposure, the subsequent plateau at a level substantially higher compared with the period preceding the media campaigns and the large increase in heterosexual males and females tested, all suggest that the campaigns have contributed to increasing awareness of HIV infection/AIDS as a major contemporary public health problem.

Risk factors for HIV-1 infection in a British population: lessons from a London sexually transmitted diseases clinic

Between September 1985 and June 1988, 6923 people (4550 men and 2373 women) were tested for HIV-1 antibodies at a sexually transmitted disease clinic, London, UK. Of the 6923 individuals tested, 558 (8%) were seropositive, of whom 523 (94%) were men and 35 (6%) women. Of the seropositives, 84% were homosexual or bisexual men, 5% were intravenous drug users, 4% were heterosexual contacts of HIV seropositives, 4% had multiple risk factors, 2% were heterosexual contacts of central African partners and 1% were heterosexuals with no other risk factors. This prevalence pattern conforms to that observed in other industrialized nations. For the women, heterosexual intercourse with an HIV-infected partner, intravenous drug use and heterosexual contact with a partner from central Africa were the main risk factors for infection. The important risk factors among the men were heterosexual contact with an HIV-seropositive partner, being homosexual or bisexual, intravenous drug use and heterosexual contact with a resident from central Africa. heterosexual and homosexual transmission were implicated as the main routes for viral spread in this British population.

Cutaneous adverse reactions to acyclovir: case reports

Intravenous, oral, and topical formulations of acyclovir have been successful in treating genital herpes. We report on two patients who developed skin reactions while taking acyclovir, which resolved when treatment was stopped.

Treatment with acyclovir of genital herpes simplex virus infection complicated by eczema herpeticum

Eczema herpeticum is a potentially serious disease that may be fatal. We report two cases of infection with genital herpes simplex virus (HSV) that were complicated by eczema herpeticum and were treated successfully with acyclovir.